O-151 ICMART preliminary world report 2018

Abstract title

International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2018

Study question

In 2018 what was global utilization, effectiveness and safety of ART?

Summary answer

Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effectiveness and safety.

What is known already

ICMART began ART global data collection in 1991. Utilization, effectiveness and safety have continuously improved with more cycles, higher pregnancy rates and lower multiple birth rates, the latter as a result of transfer of fewer embryos. Frozen embryo transfer (FET) and donor egg cycles continue to increase. However, wide variations in practice and outcomes exist globally. Approximately 9 million ART babies have been born. ICMART has helped develop registries internationally. A new electronic data collection platform has been developed in conjunction with the University of New South Wales in Sydney, Australia; nevertheless, data collection and quality remain challenging.

Study design, size, duration

Countries and regions annually collect ART data, some prospectively and others retrospectively. ICMART retrospectively requested these data from all known global sources for 2018 and reviewed them for missing or incorrect data. The dataset was corrected and then analyzed utilizing standardized definitions from The ICMART/WHO Revised Glossary on ART Terminology, 2009 which was current at the time but is now replaced by The International Glossary on Infertility and Fertility Care, 2017, and previously developed methods. Preliminary results are presented.

Participants/materials, setting, methods

The European IVF Monitoring Consortium (EIM), Latin American Network of Assisted Reproduction (REDLARA), Australian/ New Zealand Registry and African Network and Registry for ART (ANARA) submitted regional data, and other countries contributed national data, through standardized formats to ICMART. A few individual clinics with no registry access also contributed. Data were reviewed, corrected, validated to the extent possible, analyzed and summarized by ICMART using descriptive statistics.

Main results and the role of chance

Data collection and analysis are ongoing, so presented results are preliminary. The number of ART cycles continues to increase, but utilization is still highly variable among countries and regions. Regional and country differences persist in the age of women treated, number of embryos transferred, live birth rates, rate of multiple births, use of ICSI, cryopreservation cycles and other factors.

The role of chance is minimal. Actual global ART results are limited to reporting countries and clinics representing approximately 3/4 of global cycles. However, this is a very large sample size from which imputation of total global results is performed.

Limitations, reasons for caution

Some countries have limited data and many countries have limited data validation. ICMART can perform only minimal verification of submitted data. Widespread adherence to consensus definitions provided in the Glossary takes time and requires translation into multiple languages.

Wider implications of the findings

ICMART World Reports standardize data, track trends, enable comparisons, stimulate questions and improve ART quality. Better understanding of ART increases societal acceptance and support for equitable access and ART research. 

O-152 The role of South-South and Triangular Cooperation in the establishment of national and regional registries

The United Nations refers to South-South cooperation as a broad framework of collaboration between developing countries in the Global South. It can take place on a bilateral, regional, or interregional basis. Its main purpose is to share knowledge, skills, resources and successful initiatives to meet development goals through concerted partnerships. Triangular cooperation implies the presence of traditional donor countries and organizations which facilitate South-South initiatives. Both forms of cooperation carry distinct benefits and differ from the more traditional North-South partnerships.

This presentation will describe how, under the umbrella and support of ICMART, regional and interregional ART registries in the developing South, specifically the Latin American registry (REDLARA) and the African registry (ANARA), are contributing to the development, sustainability and cohesion in ART monitoring among the many countries they represent. With an innovative and standardized ART registry as a backbone, 35 countries in these two continents are now organized in regional reproductive networks increasing their recognition, visibility and impact,

We shall demonstrate that this south-south and triangular cooperation, built upon a spirit of community and regional belonging is a strong facilitator of ART monitoring and transfer of technology to the developing South, and its ongoing expansion and reach. In Latin America, where REDLARA was established 30 years ago, local and expedited channels of communication have furthermore underpinned the training of embryologists, clinicians and other health care professionals through regional networks of professionals and certified training centers. This has resulted in enhanced ART self-reliance including the capability to implement new ART technologies and also monitor their availability, utilization, effectiveness and safety. Similar initiatives, strongly supported by REDLARA and ICMART, are starting to be implemented among African institutions via ANARA.

Lastly, we shall demonstrate that our regional as well as global ART registries, together with other international organizations, have contributed to the dissemination of knowledge and serve as monitors and external quality controls now for 35 countries and almost 300 institutions in Latin America and Africa. Furthermore, given that both continents are progressively implementing the same cycle-based reporting system, new knowledge will be gained by examining regional and country similarities and differences.

20 years of the European IVF-monitoring Consortium registry: what have we learned? A comparison with registries from two other regions

STUDY QUESTION

How has the performance of the European regional register of the European IVF-monitoring Consortium (EIM)/European Society of Human Reproduction and Embryology (ESHRE) evolved from 1997 to 2016, as compared to the register of the Centres for Disease Control and Prevention (CDC) of the USA and the Australia and New Zealand Assisted Reproduction Database (ANZARD)?

SUMMARY ANSWER

It was found that coherent and analogous changes are recorded in the three regional registers over time, with a different intensity and pace, that new technologies are taken up with considerable delay and that incidental complications and adverse events are only recorded sporadically.

WHAT IS KNOWN ALREADY

European data on ART have been collected since 1997 by EIM. Data collection on ART in Europe is particularly difficult due to its fragmented political and legal landscape. In 1997, approximately 78.1% of all known institutions offering ART services in 23 European countries submitted data and in 2016 this number rose to 91.8% in 40 countries.

STUDY DESIGN, SIZE, DURATION

We compared the changes in European ART data as published in the EIM reports (2001–2020) with those of the USA, as published by CDC, and with those of Australia and New Zealand, as published by ANZARD.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We performed a retrospective analysis of the published EIM data sets spanning the 20 years observance period from 1997 to 2016, together with the published data sets of the USA as well as of Australia and New Zealand. By comparing the data sets in these three large registers, we analysed differences in the completeness of the recordings together with differences in the time intervals on the occurrence of important trends in each of them. Effects of suspected over- and under-reporting were also compared between the three registers. X² log-rank analysis was used to assess differences in the data sets.

MAIN RESULTS AND THE ROLE OF CHANCE

During the period 1997–2016, the numbers of recorded ART treatments increased considerably (5.3-fold in Europe, 4.6-fold in the USA, 3.0-fold in Australia and New Zealand), while the number of registered treatment modalities rose from 3 to 7 in Europe, from 4 to 10 in the USA and from 5 to 8 in Australia and New Zealand, as published by EIM, CDC and ANZARD, respectively. The uptake of new treatment modalities over time has been very different in the three registers. There is a considerable degree of underreporting of the number of initiated treatment cycles in Europe. The relationship between IVF and ICSI and between fresh and thawing cycles evolved similarly in the three geographical areas. The freeze-all strategy is increasingly being adopted by all areas, but in Europe with much delay. Fewer cycles with the transfer of two or more embryos were reported in all three geographical areas. The delivery rate per embryo transfer in thawing cycles bypassed that in fresh cycles in the USA in 2012, in Australia and New Zealand in 2013, but not yet in Europe. As a result of these changing approaches, fewer multiple deliveries have been reported. Since 2012, the most documented adverse event of ART in all three registers has been premature birth (<37 weeks). Some adverse events, such as maternal death, ovarian hyperstimulation syndrome, haemorrhage and infections, were only recorded by EIM and ANZARD.

LIMITATIONS, REASONS FOR CAUTION

The methods of data collection and reporting were very different among European countries, but also among the three registers. The better the legal background on ART surveillance, the more complete are the data sets. Until the legal obligation to report is installed in all European countries together with an appropriate quality control of the submitted data the reported numbers and incidences should be interpreted with caution.

WIDER IMPLICATIONS OF THE FINDINGS

The growing number of reported treatments in ART, the higher variability in treatment modalities and the rising contribution to the birth rates over the last 20 years point towards the increasing impact of ART. High levels of completeness in data reporting have been reached, but inconsistencies and inaccuracies still remain and need to be identified and quantified. The current trend towards a higher diversity in treatment modalities and the rising impact of cryostorage, resulting in improved safety during and after ART treatment, require changes in the organization of surveillance in ART. The present comparison must stimulate all stakeholders in ART to optimize surveillance and data quality assurance in ART.

STUDY FUNDING/COMPETING INTEREST(S)

This study has no external funding and all costs are covered by ESHRE. There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Magnonic Analog of Black- and White-Hole Horizons in Superfluid ^{3}He-B

We report on the theoretical model and experimental results of the experiment made in a limit of absolute zero temperature (∼600  μK) studying the spin wave analog of black- and white-hole horizons using spin (magnonic) superfluidity in superfluid ^{3}He-B. As an experimental tool simulating the properties of the black- and white-hole horizons, we used the spin-precession waves propagating on the background of the spin supercurrents between two Bose-Einstein condensates of magnons in the form of homogeneously precessing domains. We provide experimental evidence of the white hole formation for spin precession waves in this system, together with the observation of an amplification effect. Moreover, the estimated temperature of the spontaneous Hawking radiation in this system is about 4 orders of magnitude lower than the system's background temperature which makes it a promising tool for studying the effect of spontaneous Hawking radiation.

Trends over 15 years in ART in Europe: an analysis of 6 million cycles

Study question

Was the European IVF Monitoring (EIM) Consortium, established in 1999 by ESHRE, able to monitor the trend over time of ART in Europe?

Summary answer

The initial aims of the EIM programme (to collect and publish regional European data on census and trends on ART utilization, effectiveness, safety and quality) have been achieved.

What is already known

ART data in Europe have been collected and reported annually in Human Reproduction.

Study design, size, duration

A retrospective data analysis and summary of the first 15 years of ART activity in Europe (1997–2011) was carried out, using the key figures from the annual ESHRE reports and focusing on how the practice of ART has evolved over the years.

Participants/materials, setting, method

A total of 5 919 320 ART cycles are reported, including IVF, ICSI, frozen embryo relacment and egg donation, resulting in the birth of more than 1 million infants. A total of 1 548 967 IUIs are also reported, including husband/partner’s semen and donor semen cycles. The most relevant and complete data are analysed and discussed.

Main results and the role of chance

With some fluctuations, the number of countries and clinics reporting to EIM increases significantly from 1997 to 2011. A constant increase was also registered in the number of annual cycles reported. Since 2005, the estimation of the EIM coverage on the total European activity was >80%. In countries with 100% of coverage, the mean availability of ART increased from 765 cycles per million inhabitants in 1997 to 1269 cycles per million inhabitants in 2011, and the proportion of ART infants of the total number of infants born in the country increased from 1.3% to 2.4%. The proportion of women aged > 39 years undergoing IVF and ICSI cycles gradually increased. For 12 consecutive years, the proportion of ICSI versus IVF cycles showed a marked increase before reaching a plateau from 2008. The proportion of transfers with three or more embryos decreased constantly and the proportion of SETs increased over the time period. The triplets deliveries were reduced from 3.7% in 1997 to less than 1% since 2005 (0.6% in 2011). The effectiveness (evaluated as clinical pregnancy rate per aspiration and per embryo transfer) increased until 2007, then the figure remained stable. The cumulative percentage of documented pregnancy losses was 17%. No differences have been noted in terms of outcomes in the IUI cycles.

Limitations, reasons for caution

The data presented are accumulated from countries with different collection systems, regulations, insurance coverage and different practices. Each year a number of countries have been unable to provide some of the data.

Wider implications of the finding(s)

The first summary of 15 years of the EIM reports offers interesting data on census and trends on ART utilization, safety and quality in Europe. The primary aim of the ESHRE effort in supporting European data collection has been reached. Owing to its importance inside and outside the professional community, European data collection and publication on ART have to be supported and implemented.

Study funding/competing interest(s)

None.

Oocyte and ovarian tissue cryopreservation in European countries: statutory background, practice, storage and use

STUDY QUESTION

What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and ‘non-medical’) and specific number of cycles?

SUMMARY ANSWER

Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for ‘non-medical’ OoC.

WHAT IS ALREADY KNOWN

The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries.

STUDY DESIGN, SIZE, AND DURATION

A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, ‘other medical’ reasons as part of an ART cycle, as well as for ‘non-medical reasons’ or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire.

MAIN RESULTS AND THE ROLE OF CHANCE

Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was ‘serious disease’ such as cancer in 10.9% of cycles, other medical indications as ‘part of an ART cycle’ in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues.

LIMITATIONS, REASONS FOR CAUTION

Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC.

WIDER IMPLICATIONS OF THE FINDINGS

There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved.

STUDY FUNDING/COMPETING INTEREST(S)

The study was supported by ESHRE. There are no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates

STUDY QUESTION

What is the success rate in terms of ovarian activity (menstrual cycles) as well as pregnancy and delivery rates 1 year after orthotopic ovarian transplantations conducted in a three-country network?

SUMMARY ANSWER

In 49 women with a follow-up >1 year after transplantation, the ovaries were active in 67% of cases and the pregnancy and delivery rates were 33 and 25%, respectively.

WHAT IS KNOWN ALREADY

Cryopreservation of ovarian tissue in advance of cytotoxic therapies and later transplantation of the tissue is being performed increasingly often, and the total success rates in terms of pregnancy and delivery have been described in case series. However, published case series have not allowed either a more detailed analysis of patients with premature ovarian insufficiency (POI) or calculation of success rates based on the parameter 'tissue activity'.

STUDY DESIGN, SIZE, DURATION

Retrospective analysis of 95 orthotopic transplantations in 74 patients who had been treated for cancer, performed in the FertiPROTEKT network from 2008 to June 2015. Of those 95 transplantations, a first subgroup (Subgroup 1) was defined for further analysis, including 49 women with a follow-up period >1 year after transplantation. Of those 49 women, a second subgroup (Subgroup 5) was further analysed, including 40 women who were transplanted for the first time and who were diagnosed with POI before transplantation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Transplantation was performed in 16 centres and data were transferred to the FertiPROTEKT registry. The transplantations were carried out after oncological treatment had been completed and after a remission period of at least 2 years. Tissue was transplanted orthotopically, either into or onto the residual ovaries or into a pelvic peritoneal pocket. The success rates were defined as tissue activity (menstrual cycles) after 1 year (primary outcome) and as pregnancies and deliveries achieved.

MAIN RESULTS AND THE ROLE OF CHANCE

The average age of all transplanted 74 women was 31 ± 5.9 years at the time of cryopreservation and 35 ± 5.2 at the time of transplantation. Twenty-one pregnancies and 17 deliveries were recorded. In Subgroup 1, tissue was cryopreserved at the age of 30 ± 5.6 and transplanted at 34 ± 4.9 years. Ovaries remained active 1 year after transplantation in 67% of cases (n = 33/49), the pregnancy rate was 33% (n = 16/49) and the delivery rate was 25% (n = 12/49). In Subgroup 5, tissue was cryopreserved at the age 30 ± 5.9 years and transplanted at 34 ± 5.2 years. Ovaries remained active 1 year after transplantation in 63% of cases (n = 25/40), the pregnancy rate was 28% (n = 11/40) and the delivery rate was 23% (n = 9/40). The success rates were age dependant with higher success in women who cryopreserved at a younger age. In Subgroup 5, tissue was exclusively transplanted into the ovary in 10% (n = 4/40) of women and into a peritoneal pocket in 75% (n = 30/40), resulting in spontaneous conceptions in 91% of patients (n = 10/11).

LIMITATIONS, REASONS FOR CAUTION

The data were drawn from a retrospective analysis. The cryopreservation and transplantation techniques used have changed during the study period. The tissue was stored in many tissue banks and many surgeons were involved, leading to heterogeneity of the procedures. However, this does reflect the realistic situation in many countries. Although patients with POI were evaluated before transplantation to allow specific analysis of the transplanted tissue itself, the possibility cannot be excluded that residual ovarian tissue was also reactivated.

WIDER IMPLICATIONS OF THE FINDINGS

This is the largest case series worldwide to date and it confirms that cryopreservation and transplantation of ovarian tissue can be a successful option for preserving fertility. Persistent tissue activity 12 months after transplantation suggests that the pregnancy and delivery rates may increase further in the future. As transplantation into the peritoneum results in a high success rate, this approach may be an alternative to transplantation into the ovary. However, in order to establish the best transplantation site, a randomized study is required.

STUDY FUNDING/COMPETING INTEREST

This study was in part funded from the Deutsche Forschungsgemeinschaft (# DI 1525) and the Wilhelm Sander Foundation (2012.127.1) and did not receive any funding from a commercial company. No competing interests.

TRIAL REGISTRATION NUMBER

None.

[Effect of resilience in women on the outcome of her first IVF/ICSI]

OBJECTIVE

To examine whether women´s well-being and coping strategies are associated with IVF outcomes.

DESIGN

Prospective study.

SETTING

Centre of assisted reproduction Sanus, Pardubice; PPCHC s.r.o. Hradec KrálovéMethods: Study included these methods of data collection; Psychological well-being was mesured by Dotazník životní spokojenosti (Questionnaire of well-being,n = 103) and coping strategies were mesured by COPE Invetory (n = 82). In the years 2010-2013 women attending their first cycle IVF/ICSI (younger than 35 years) were asked to fill in the psychological questionnaires prior to collection of oocytes. Then the result of IVF/ICSI was observed - a clinically recognized pregnancy. We compared general well-being, satisfaction with their own health, marital satisfaction and emotion focused coping strategies: Acceptance, Positive reinterpretation and Seeking of emotional social support, between pregnant and non-pregnant women.

RESULTS

There were no statistically significant differences between women who became pregnant and those who did not in general well-being (t = -0.9,p = 0.37), satisfaction with their own health (t = -0.6, p = 0.52), marital satisfaction (t = -0.8, p = 0.44), use of Acceptance (t = 0.9 , p = 0.36) and Positive reinterpretation (t = -0.8, p = 0.43). The only factor that was significantly associated with pregnancy outcome was Seeking of emotional social support (t = 2.3, p = 0.02).

CONCLUSION

We found no evidence that psychological well-being had any influence on the outcome of IVF/ICSI treatment. In case of emotion focused coping we found that women who became pregnant used significantly more often strategy called Seeking of emotional social support than women who remained nonpregnant.

Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE

BACKGROUND

This 12th European IVF-monitoring (EIM) report presents the results of treatments involving assisted reproductive technology (ART) initiated in Europe during 2008.

METHODS

From 36 countries (3 more compared with 2007), 1051 clinics reported 532 260 treatment cycles including: IVF (124 539), ICSI (280 552), frozen embryo replacements (FER, 97 120), egg donation (ED, 13 609), in vitro maturation (IVM, 562), preimplantation genetic diagnosis/screening (PGD/PGS, 2875) and frozen oocyte replacements (FOR, 4080). Overall, this represents a 7.9% increase in the activity since 2007, which is mainly related to an increase in cycles from almost all registers and only partially to the new countries entering EIM (Estonia, Kazakhstan, Moldova and Romania, 5480 cycles in total). European data on intrauterine insemination using husband/partner's (IUI-H) and donor (IUI-D) semen were reported from 27 and 21 countries, respectively. A total of 144 509 IUI-H (+1.5%) and 24 960 IUI-D (-4.3%) cycles were included.

RESULTS

In 19 countries where all clinics reported to the ART register, a total of 350 143 ART cycles were performed in a population of 369.8 million, corresponding to 947 cycles per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 28.5 and 32.5%, respectively, and for ICSI the corresponding rates were 28.7 and 31.9%. In FER cycles, the pregnancy rate per thawing was 19.3%. The delivery rate after IUI was 9.1% for IUI-H and 13.8% for IUI-D. In IVF and ICSI cycles, one, two, three and four or more embryos were transferred in 22.4, 53.2, 22.3 and 2.1%, respectively. The proportions of singleton, twin and triplet deliveries after IVF and ICSI (combined) were 78.3, 20.7 and 1.0%, respectively, resulting in a total multiple delivery rate of 21.7%, compared with 22.3% in 2007, 20.8% in 2006 and 21.8% in 2005. In FER cycles, the multiple delivery rate was 13.7% (13.4% twins and 0.3% triplets). In women undergoing IUI, twin and triplet deliveries occurred in 10.6% and 0.7% with IUI-H and in 9.4 and 0.3% with IUI-D, respectively.

CONCLUSIONS

In comparison with previous years, there was an increase in the reported number of ART cycles in Europe. For the first time in 5 years, the pregnancy rates failed to show a year-on-year increase. Compared with 2007, the number of transfers of multiple embryos (3+) and a multiple delivery rate showed a marginal decline.

Assisted reproductive technology in Europe, 2007: results generated from European registers by ESHRE

BACKGROUND

This 11th European IVF-monitoring report presents the results of assisted reproductive technology (ART) treatments initiated in Europe during 2007.

METHODS

From 33 countries, 1029 clinics reported 493 184 treatment cycles: IVF (120 761), ICSI (256 642), frozen embryo replacement (91 145), egg donation (15 731), preimplantation genetic diagnosis/preimplantation genetic screening (4638), in vitro maturation (660) and frozen oocytes replacements (3607). Overall, this represents a 7.6% increase since 2006, mostly related to an increase in all registers. IUI using husband/partner's (IUI-H) and donor (IUI-D) semen was reported from 23 countries: 142 609 IUI-H (+6.2%) and 26 088 IUI-D (+7.2%).

RESULTS

In 18 countries where all clinics reported, 376 971 ART cycles were performed in a population of 425.6 million (886 cycles per million). The clinical pregnancy rates per aspiration and per transfer were 29.1 and 32.8% for IVF, and 28.6 and 33.0% for ICSI. Delivery rate after IUI-H was 10.2% in women aged < 40 years. In IVF/ICSI cycles, 1, 2, 3 and ≥4 embryos were transferred in 21.4, 53.4, 22.7 and 2.5% of cycles, with no decline in the number of embryos per transfer since 2006. The proportion of multiple deliveries (22.3: 21.3% twin and 1.0% triplet), did not decrease compared with 2006 (20.8%) and 2005 (21.8%). In women < 40 years undergoing IUI-H, twin deliveries occurred in 11.7% and triplets in 0.5%.

CONCLUSIONS

In comparison with previous years, the reported number of ART cycles in Europe increased in 2007; pregnancy rates increased marginally, but the earlier decline in the number of embryos transferred and multiple births did not continue.

P5-14-05: Anti-Müllerian Hormone (AMH) Levels in Premenopausal Breast Cancer Patients Treated with Adjuvant Chemotherapy – A Translational Research Project of the SUCCESS Study

Background: Premenopausal women undergoing chemotherapy are at risk of premature ovarian failure and long term side-effects caused by premature menopause. However, knowledge about the rate of ovarian failure and potential markers to evaluate the ovarian reserve is limited, especially in the context of modern chemotherapy concepts. Therefore, Anti-Müllerian hormone (AMH) was measured at before, immediately after and 2 years after chemotherapy in premenopausal patients of the SUCCESS study.

Materials and Methods: The German SUCCESS trial is a multicenter phase III study comparing FEC-Docetaxel vs. FEC-Docetaxel+Gemcitabine as adjuvant treatment in patients with node positive or high risk node negative primary breast cancer. Blood samples were taken prior to and 4 weeks after last cycle of adjuvant chemotherapy, as well as after 2 years of follow up. We retrospecitvely identified 170 patients stratified premenopausal and aged 40 years or younger at trial entry, who received 3cycles of FEC (500/100/500mg/m2) q3w followed by 3 cycles of docetaxel (100mg/m2) q3w as one of the most commonly used chemotherapy regimens in Europe. Serum AMH levels were evaluated in a central laboratory by a manual immunoassay AMH DSL ELISA (Diagnostic Systems Laboratories, Webster, USA).

Results: Median age within this subgroup was 36 years (21-40 years). 48% of the patients had a tumor stage pT1 and 54% were node positive. 69% were hormone receptor positive and 29% Her2 positive. Median serum AMH level before adjuvant chemotherapy was 1.32 ng/ml (range &lt;0.1−11.32). Immediately after chemotherapy AMH levels dropped in 96% of the patients below the threshold of detection (&lt;0.1 ng/ml, range &lt;0.1−3.9ng/ml). No association to classical prognostic markers, such as tumor stage, lymph node involvement, etc. was observed. After a follow up period of 2 years, serum was available from 95 patients. 76% of those patients showed no evidence of ovarian function indicated by AMH (&lt;0.1 ng/ml, range &lt;0.1−1.43ng/ml). AMH levels prior to and 2 years after chemotherapy were significantly correlated with older age, with a reduction of 0.14 ng/ml per life year (p=0.0025) and 0.01 ng/ml (p=0.017) respectively. 12 patients (7%) received optional gonadotropin-releasing hormone (GnRH) agonists during chemotherapy. These patients presented significantly higher AMH levels (+ 0.18 ng/ml; p=0.01) 2 years after cytotoxic treatment. Conclusion: In this retrospective analysis premenopausal patients showed a high rate of ***f ovarian insufficiency reflected by low serum AMH levels immediately after cytotoxic treatment and after 2 years of follow up. GnRH agonists given as ovarian protectants during chemotherapy may have an influence on serum AMH 2 years after chemotherapy. Further data from prospective trials with longer follow up are needed to evaluate the role of serum AMH as a predictor of ovarian failure in breast cancer patients exposed to chemotherapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-05.

Catalytic mechanism of S-type phycobiliprotein lyase: chaperone-like action and functional amino acid residues

The phycobilin:cysteine 84-phycobiliprotein lyase, CpcS1, catalyzes phycocyanobilin (PCB) and phycoerythrobilin (PEB) attachment at nearly all cysteine 82 binding sites (consensus numbering) of phycoerythrin, phycoerythrocyanin, phycocyanin, and allophycocyanin (Zhao, K. H., Su, P., Tu, J. M., Wang, X., Liu, H., Plöscher, M., Eichacker, L., Yang, B., Zhou, M., and Scheer, H. (2007) Proc. Natl. Acad. Sci. U.S.A. 104, 14300-14305). We now show that CpcS1 binds PCB and PEB rapidly with bi-exponential kinetics (38/119 and 12/8300 ms, respectively). Chromophore binding to the lyase is reversible and much faster than the spontaneous, but low fidelity chromophore addition to the apo-protein in the absence of the lyase. This indicates kinetic control by the enzyme, which then transfers the chromophore to the apo-protein in a slow (tens of minutes) but stereo- and regioselectively corrects the reaction. This mode of action is reminiscent of chaperones but does not require ATP. The amino acid residues Arg-18 and Arg-149 of the lyase are essential for chromophore attachment in vitro and in Escherichia coli, mutations of His-21, His-22, Trp-75, Trp-140, and Arg-147 result in reduced activity (<30% of wild type in vitro). Mutants R147Q and W69M were active but had reduced capacity for PCB binding; additionally, with W69M there was loss of fidelity in chromophore attachment. Imidazole is a non-competitive inhibitor, supporting a bilin-binding function of histidine. Evidence was obtained that CpcS1 also catalyzes exchange of C-beta84-bound PCB in biliproteins by PEB.

New non-Goldstone collective mode of BEC of magnons in superfluid 3He-B

Bose-Einstein condensation of magnons in superfluid 3He-B is experimentally manifested by various states where coherent spin precession is established spontaneously, even in nonhomogeneous magnetic fields. Once such a condensate with coherent spin precession is created, it occupies the state with minimal energy, the ground state. The application of an additional magnetic field to that condensate may cause its deflection from the energy minimum and the condensate responds by creating collective gapless oscillations known as Goldstone modes. This Letter reports the experimental observation of a new (non-)Goldstone mode, which can be viewed as an additional NMR mode of condensed magnons in a rotating frame of reference.

Intermediate binding of phycocyanobilin to the lyase, CpeS1, and transfer to apoprotein

The phycobilin: Cysteine-84-phycobiliprotein lyase, CpeS1, catalyzes phycocyanobilin (PCB) and phycoerythrobilin attachment to nearly all cysteine-84 (consensus sequence) binding sites of phycoerythrin, phycoerythrocyanin, phycocyanin and allophycocyanin (Zhao et al. (2007) Proc Natl Acad Sci 104:14300-14305). We now show that CpeS1 can bind PCB, as assayed by Ni(2+) chelating affinity chromatography. Binding is rapid, and the chromophore is bound in an extended conformation similar to that in phycobiliproteins but only poorly fluorescent. Upon addition of apo-biliproteins, the chromophore is transferred to the latter much slower ( approximately 1 h), indicating that chromophorylated CpeS1 is an intermediate in the enzymatic reaction. In addition, imidazole is bound to PCB, as shown by mass spectroscopy of tryptic digests of the intermediate CpeS1-PCB complex.

Unfolding of C-phycocyanin followed by loss of non-covalent chromophore-protein interactions 1. Equilibrium experiments

Optical spectroscopic properties of the covalently linked chromophores of biliproteins are profoundly influenced by the state of the protein. This has been used to monitor the urea-induced denaturation of C-phycocyanin (CPC) from Mastigocladus laminosus and its subunits. Under equilibrium conditions, absorption, fluorescence and circular dichroism of the chromophores were monitored, as well as the circular dichroism of the polypeptide. Treatment of CPC trimers (alphabeta)3 resulted first in monomerization (alphabeta), which was followed by a complex unfolding process of the protein. Loss of chromophore fluorescence is the next process at increasing urea concentrations; it indicates increased flexibility of the chromophore while maintaining the native, extended conformation, and a less compact but still native-like packing of the protein in the regions sampled by the chromophores. This was followed by relaxation of the chromophores from the energetically unfavorable extended to a cyclic-helical conformation, as reported by absorption and CD in the visible range, indicating local loss of protein structure. Only then is the protein secondary structure lost, as reported by the far-UV CD. Sequential processes were also seen in the subunits, where again the chromophore-protein interactions were reduced before the unfolding of the protein. It is concluded that the bilin chromophores are intrinsic probes suitable to differentiate among different processes involved in protein denaturation.

Contractile reactivity of human myometrium in isolated non-pregnant uteri

BACKGROUND

Perfusion of the isolated uterus has been shown to be a feasible experimental system for studies of the human endometrium and myometrium. Utilizing our established experimental perfusion model we perfused 20 uteri for 27 h and investigated the contractile reactivity of the myometrium in response to 17beta-estradiol (E2) and oxytocin (OT).

METHODS

Uteri of group A (n = 4) were stimulated with OT; group B (n = 4) was treated continuously with E2; group C (n = 4) received both E2 and OT for 27 h; group D (n = 4) was perfused for 27 h with E2 with the addition of OT for the last 3 h of the experiment; group E (n = 4) as control group remained without any treatment. The pressure and duration of uterine contractions were recorded during the entire perfusion period using intramural and endoluminal pressure catheters.

RESULTS

Compared to the other treatment groups and controls, the most effective myometrial activity was achieved in group D during the OT stimulation period. No relevant myometrial activity was detected in the control group.

CONCLUSIONS

Continuous E2 treatment, with the addition of OT for the last 3 h of the 27 h perfusion period, led to the most pronounced uterotonic effects in the presented experimental condition.

Photochromic Biliproteins from the Cyanobacterium Anabaena sp. PCC 7120: Lyase Activities, Chromophore Exchange, and Photochromism in Phytochrome AphA

Photochromic biliproteins can be switched by light between two states, initiated by Z/E photoisomerization of the linear tetrapyrrole chromophore. The cyanobacterium Anabaena sp. PCC 7120 contains three genes coding for such biliproteins, two coding for phytochromes (aphA/B) and one for the alpha subunit of phycoerythrocyanin (pecA). (a) aphA was overexpressed in Escherichia coli with N-terminal His and S tags, and the protein was reconstituted by an optimized protocol with phycocyanobilin (PCB), to yield the photochromic chromoprotein, PCB-AphA, carrying the PCB chromophore. (b) AphA chromophorylation is autocatalytic such as in other phytochromes. (c) AphA chromophorylation is also possible by chromophore transfer from the PCB-carrying biliprotein, phycocyanin (CPC). The autocatalytic transfer is very slow, and it is enhanced more than 100-fold by catalysis of PCB:CpcA lyase and alpha-CPC as donor. (d) Through deletion mutations of aphA, a short sequence IQPHGV [amino acids (aa) 26-31] was found essential for the lyase activity of AphA, indicating an interaction of the N terminus with the chromophore-binding domain around cysteine 259. (e) A motif of at least 23 aa, starting with this sequence and located approximately 250 aa N terminal of the chromophore-binding cysteine, is proposed to relate to the lyase function in plant and most prokaryotic phytochromes. (f) Long-range interactions in AphA are further supported by blue-shifted absorptions (<or=12 nm) of both the Pr and Pfr forms of truncated chromoproteins.

Oxytocin receptor gene expression of estrogen-stimulated human myometrium in extracorporeally perfused non-pregnant uteri

Oxytocin (OT) and the oxytocin receptor (OTR) seem to be less important for uterine contractility-associated disorders of the non-pregnant uterus compared to the pregnant uterus. In the present study, we investigated the mutual dependence of OTR, OT and 17beta-estradiol (E(2)) with regard to the localization of OTR in the non-pregnant uterus. Utilizing our established model for extracorporeal perfusion of the human uterus, we perfused 15 human uteri for 27 h under physiological conditions without oestradiol (group A, n = 5) or with high E(2) stimulation (group B, n = 5) followed by OT stimulation for both groups during the last 3 h of the experiment. Negative controls (n = 5) remained in perfusions for 27 h without any further hormone treatment. Gene expression of the myometrial OTR in both groups was compared using reverse transcriptase triple primer PCR. Stimulation with E(2) and OT led to significantly higher OTR gene expression than stimulation with OT alone. We also showed that concentrations of OTR transcripts increase from the lower uterine segment to the uterine fundus. However, maximum OTR levels of the uterine fundus in group B did not reach concentrations of specimens of third trimester of pregnancy which were used as positive controls. We conclude that our experimental model simulates a situation similiarly to the stimulated non-pregnant uterus in the therapeutic concepts of assisted reproduction. The data presented demonstrate that the dynamics of OTR expression can be modulated by stimulation with E(2) and OT, not only in the pregnant but also in the non-pregnant uterus.

Energy transfer in monomeric phycoerythrocyanin

Phycoerythrocyanin (PEC) is part of the phycobilisome of cyanobacteria. Its monomer carries one phycoviolobilin and two phycocyanobilins (PCB) as chromophores. For an understanding of the complicated energy transfer in phycobilisomes, a detailed knowledge of the processes in the constituting building proteins is indispensable. We report the experimental data necessary for the description of Förster energy transfer in monomeric PEC, including fluorescence lifetimes and quantum yields of the two subunits. The bulk experiments are complemented by studies of single PEC molecules. Förster energy calculations and Monte Carlo simulations based on the bulk data are presented. They reveal that earlier experimental findings of energy transfer heterogeneities in single PEC molecules originate in spectral shifts between the contributing chromophores.

Paraneoplastic neurological syndrome: patient with anti-Yo antibody and breast cancer: a case report

Presented here is the case of a paraneoplastic cerebral degeneration (PCD) in a female patient with breast cancer and the indication of anti-Yo antibodies in the cerebrospinal fluid (CSF) and serum. The patient's primary indications were dizziness and a severe gait ataxia. The indication of anti-Yo antibodies led to the conclusion of the existence of a paraneoplastic cerebral degeneration. The antibodies in question are anti-Purkinje-cell autoantibodies acting against the antigens common to tumor and Purkinje cells which occur in association with a certain percentage of breast or ovarian cancers. The diagnosis of the primary tumor, that is clinically undetectable with conventional imaging processes, is performed with the aid of positron emission tomography (PET) to detect the presence of axillary lymph node metastases. The micro-invasive mammary carcinoma was able to be localized with the aid of MR mammography and, after MR mammography marking, was removed. The patient subsequently received adjuvant treatment with epirubicine and cyclophosphamide. This treatment failed to influence the paraneoplastic neurological symptoms.

Spin precession waves in superfluid 3He-B

Spin precession waves of homogeneously precessing domains (HPD) in superfluid 3He-B have been studied at 11 bars and temperatures down to 0.45T(c). The waves were excited by an alternating longitudinal magnetic field with an axial symmetry, applied as a small perturbation ranging from 1 nT up to a few micro T. When the spin precession wave is excited, two nuclear magnetic resonances simultaneously coexist: first, the high frequency resonance used for excitation of the HPD, and, second, the low-frequency resonance of the HPD wave mode. We report the first experimental evidence of the nonlinear behavior of low-frequency precession spin wave modes of the continuously maintained HPD.

Bowenoid papulosis of the vulva-immunotherapeutical approach with topical imiquimod

INTRODUCTION

Bowenoid papulosis is a characteristic lesion of the ano-genital region and represents a form of squamous cell carcinoma in situ, very often associated to the oncogenic high-risk human papilloma virus (HPV) types 16, 18, 31 and 33. Therapies applied so far, in general, show high rates of relapse, and patients complain of pruritus and pain. Imiquimod cream is a topical immune response modifier with indirect antiviral and antitumor effects through the stimulation of local cytokine production and cell-mediated immune response.

CASE REPORT

In the present paper we report on the topical application of imiquimod cream in a woman with a high-risk HPV-associated vulvar intraepithelial neoplasia grade III (VIN III) of the vulva.

DISCUSSION

In addition a review of the literature is given.

Extracorporeal perfusion of the human uterus as an experimental model in gynaecology and reproductive medicine

Experimental perfusion of various organs has primarily been used in transplantation medicine to study the physiology, pathophysiology and metabolism of tissues and cells. The purpose of this study was to establish an experimental model for the extracorporeal perfusion of the human uterus with recirculation of a modified, oxygenated Krebs-Henselait solution, in comparison with a non-recirculating perfusion system. With consent of the patients we obtained 25 uteri after standard hysterectomy. We performed an isovolumetric exchange of the perfusion medium at different intervals from 1 to 6 h and examined pH, pO(2), pCO(2), lactate, lactate dehydrogenase and creatine kinase by taking arterial and venous samples every hour for 24 h. We found the perfusions to be adequate when maintaining flow rates at 15-35 ml/min and at pressures ranging from 70 to 130 mmHg. Isovolumetric exchange of the perfusate every 3-4 h was the maximum interval to keep pH, the arterio-venous gradients of pO(2) and pCO(2), and the other biochemical parameters in physiological ranges. Examination by light and electron microscopy showed well-preserved features of myometrial and endometrial tissue. However, a 6 h exchanging interval led to increasing hypoxic and cytolytic parameters during the whole perfusion period. X-ray studies using digital subtraction angiography and perfusion studies with methylene blue demonstrated the homogeneous distribution of the perfusion fluid throughout the entire organ.

[Gynecological ultrasound network: new concepts]

Digital data processing and storage are advancing in many medical settings. Some ultrasound machines process, store and provide images digitally. For many obstetrical and gynecological ultrasound units electronic filing and reporting are essential parts of their documentation. However, patient data are often entered redundantly into the different systems (admission and billing, encoding of diagnoses, medical reports etc.). Bi-directional exchange of textual data is the first step towards successful integration. Additionally, affordable central digital video storage from different sources within a department or hospital will soon become available.